Debate over how to fix the bleak financial outlook for University Medical Center — which is projected to lose $87 million next year — has divided the Clark County Commission in recent months.

On Wednesday, commissioners briefly set aside their differences during a presentation on UMC’s budget, which is projected to be $550 million next year. But they laid the groundwork for what could be a contentious debate in two weeks when they will discuss changes to the hospital’s governance and a potential countywide tax to help pay for hospital operations.

About half of the hospital’s $87 million shortfall will be offset by federal funding, but the county will still have to contribute at least $31 million and possibly more to make ends meet, CEO Brian Brannman told county commissioners Wednesday.

That subsidy comes on top of the $100 million in funding the county already contributes each year to UMC.

Brannman attributed the hospital’s perpetual losses to a variety of factors, including serving a high number of uninsured patients and bad reimbursement contracts negotiated with insurance providers under a previous administration.

UMC’s perilous position will only worsen going forward as the Affordable Care Act is implemented, which is expected to lead to the expansion of Medicaid as well as reductions of reimbursement rates, which will cost the hospital more than $30 million over the next five years.

The large increase in access to health insurance will force UMC to compete with other local hospitals for patients, Brannman said, which will require increased capital investment.

The hospital has more than 700 pieces of equipment that are past their useful life and will need $78.1 million to fund equipment purchases, facilities upgrades and building projects over the next five years, he said.

Commissioners agree that strong action is needed to put UMC on more solid financial footing, but disagree on how to best accomplish that goal.

Commission Chairman Steve Sisolak said he thinks the hospital should be overseen by a group of medical and business experts instead of county commissioners.

Also scheduled for discussion at that meeting is a proposal to consider a countywide tax to help fund hospital operations.

Commissioners Chris Giunchigliani, Tom Collins and Lawrence Weekly — who all oppose the governance change — argued Wednesday that the hospital’s problems won’t be solved until a dedicated funding source is established.

Weekly, who chairs UMC’s board of trustees, said he wants to see UMC find ways to increase its internal revenues, but at the end of the day, the hospital must be funded, even if that means a subsidy from the county.

If the county can show it will use the money responsibly, Weekly said he thinks taxpayers will be receptive to paying a bit more to keep UMC strong.

“If you’re making sure you’re using taxpayer dollars responsibly and not spending them frivolously, taxpayers will support something like this,” he said. “People support doing the right thing for those (in need) as long as government doesn’t take advantage of them.”